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Recalcitrant carpal tunnel syndrome presents a clinical challenge. Potential etiologies of persistent or recurrent symptoms after primary carpal tunnel release include incomplete nerve decompression, secondary sites of nerve compression, unrecognized anatomic variations, irreversible nerve pathology associated with chronic compression neuropathy, perineural adhesions, conditions associated with secondary nerve compression, iatrogenic nerve injury, or inaccurate preoperative diagnosis. Understanding the pertinent surgical anatomy and pathophysiology is essential toward developing an effective diagnostic and treatment strategy. A thorough clinical history and examination guide a comprehensive diagnostic evaluation that includes serial examinations, neurophysiologic testing, and imaging studies. Conservative treatment may provide symptomatic relief; however, surgical management involving revision neuroplasty, neurolysis, nerve reconstruction, and/or local soft-tissue flap augmentation may be indicated in refractory cases.
This article was published in the following journal.
Name: The Journal of the American Academy of Orthopaedic Surgeons
Carpal tunnel syndrome is the most common compression syndrome of a peripheral nerve. It mostly affects patients older than 50 years. One cause for a carpal tunnel syndrome is transthyretin (ATTR) amy...
Carpal tunnel syndrome (CTS) is the most common peripheral nerve neuropathy resulting from compression of the median nerve as it traverses the carpal tunnel. The pathophysiology of this condition is m...
We evaluated the relationship between the area around the distal radioulnar joint according to the ulnar variances and the cross-sectional area using magnetic resonance imaging (MRI) scans in this pro...
The objective of this study was to investigate the incidence of familial carpal tunnel syndrome in patients admitted to the authors' institution for carpal tunnel release. Questionnaires completed by ...
Assess the effect of chronic comorbidities on hours and earnings recovery following a carpal tunnel syndrome (CTS) claim.
Carpal tunnel syndrome (CTS) is a common condition that still lacks a reliable, objective screening test. Many anatomical aspects of the syndrome have been studied including the dimensions...
The Carpal Tunnel Syndrome Diagnosis and Treatment Trial is project #1 of the Multidisciplinary Clinical Research Center focused on upper extremity pain. It is a randomized trial comparin...
The aim of this study is in a prospective, consecutive series of diabetic patients with carpal tunnel syndrome, who are then age and gender matched with non-diabetic patients having idiopa...
Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment. Diagnosis is based on symptoms, clinical findings and electrophysiological examination. Several conservative an...
The purpose of our study is to evaluate the effectiveness of the home exercise program in patients who develop Carpal tunnel syndrome (CTS).
Entrapment of the MEDIAN NERVE in the carpal tunnel, which is formed by the flexor retinaculum and the CARPAL BONES. This syndrome may be associated with repetitive occupational trauma (CUMULATIVE TRAUMA DISORDERS); wrist injuries; AMYLOID NEUROPATHIES; rheumatoid arthritis (see ARTHRITIS, RHEUMATOID); ACROMEGALY; PREGNANCY; and other conditions. Symptoms include burning pain and paresthesias involving the ventral surface of the hand and fingers which may radiate proximally. Impairment of sensation in the distribution of the median nerve and thenar muscle atrophy may occur. (Joynt, Clinical Neurology, 1995, Ch51, p45)
Disease involving the median nerve, from its origin at the BRACHIAL PLEXUS to its termination in the hand. Clinical features include weakness of wrist and finger flexion, forearm pronation, thenar abduction, and loss of sensation over the lateral palm, first three fingers, and radial half of the ring finger. Common sites of injury include the elbow, where the nerve passes through the two heads of the pronator teres muscle (pronator syndrome) and in the carpal tunnel (CARPAL TUNNEL SYNDROME).
Disorders of the peripheral nervous system associated with the deposition of AMYLOID in nerve tissue. Familial, primary (nonfamilial), and secondary forms have been described. Some familial subtypes demonstrate an autosomal dominant pattern of inheritance. Clinical manifestations include sensory loss, mild weakness, autonomic dysfunction, and CARPAL TUNNEL SYNDROME. (Adams et al., Principles of Neurology, 6th ed, p1349)
The articulations between the various CARPAL BONES. This does not include the WRIST JOINT which consists of the articulations between the RADIUS; ULNA; and proximal CARPAL BONES.
Compression of the ULNAR NERVE in the cubital tunnel, which is formed by the two heads of the flexor carpi ulnaris muscle, humeral-ulnar aponeurosis, and medial ligaments of the elbow. This condition may follow trauma or occur in association with processes which produce nerve enlargement or narrowing of the canal. Manifestations include elbow pain and PARESTHESIA radiating distally, weakness of ulnar innervated intrinsic hand muscles, and loss of sensation over the hypothenar region, fifth finger, and ulnar aspect of the ring finger. (Joynt, Clinical Neurology, 1995, Ch51, p43)
Surgery is a technology consisting of a physical intervention on tissues. All forms of surgery are considered invasive procedures; so-called "noninvasive surgery" usually refers to an excision that does not penetrate the structure being exci...